| UnitedHealthcare |
| dimethyl fumarate (dimethyl fumarate) |
| Drugs for the Nervous System : Drugs for Multiple Sclerosis |
- Multiple Sclerosis (MS):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Patients Cardiac Medical History Required: No
Concomitant use of other MS medication: No
- Quantity Limit: limit maximum 56 EA PER 365 day(s)
- Prior Authorization: Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Duration: 12 Month(s)
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